St George’s Healthcare NHS Trust CQC report April 2014 Inspection Chair: Gillian Hooper Team Leader: Fiona Allinson Quality Summit 22 April 2014 Background Strategy 2013 - 2016 Raising standards, putting people first, published April 2013 June 2013 First of a series of consultations on significant changes – Principles of new model for all care services Detail of NHS intelligence model, inspection and ratings Regulations underpinning the changes Further consultation in October 2013 on further detail and guidance on NHS regulation, fundamentals of care Co-development, engagement and further consultation throughout 1 1

Context for this trust The trust is a large sized acute trust with over 1000 beds, 105,000 admissions, 120,000 A&E attendances and 586,000 outpatient attendances pa The trust offers very specialist care for the most complex of injuries and illnesses, including trauma, neurology, cardiac care, renal transplantation, cancer care and stroke alongside the provision of community services from two hospital sites, a therapy centre and a range of health centres. It serves the 121st deprived population in England, with below average life expectancy and some specific health problems such as diabetes.

CQC Inspection: 10-14 February 2014 The inspection covered St George’s Hospital Queen Mary’s Hospital St John’s Therapy Centre and health centres The inspection covered the full range of community health services provided by the trust This was selected because it was a low risk trust to be inspected using the CQC’s new approach to ensure that the methodology applied to all trusts.

The CQC’s new approach (1) 3 Phases: Pre-inspection Inspection Report and Quality Summit Pre-inspection: Planning inspection Development of a data packs Recruitment of inspection team Inspection: 4 days 62 team members Listening event, focus groups, interviews and visits to clinical areas

CQC’s 5 key questions Safe? Are people protected from abuse and avoidable harm? Effective? Does people’s care and treatment achieve good outcomes and promote a good quality of life, and is it evidence- based where possible? Caring? Do staff involve and treat people with compassion, kindness, dignity and respect? Responsive? Are services organised so that they meet people’s needs? Well-led? Does the leadership, management and governance of the organisation assure the delivery of high-quality patient- centred care, support learning and innovation and promote an open and fair culture?

The CQC’s new approach (2) 8 core acute services: A&E Medical Care Surgical Care & Theatres Critical Care Maternity & Family Planning Children and Young People’s Care End of Life Care Outpatients 3 core community services: Community In Patients Long Term Conditions Children & Families

Ratings CQC has been tasked with rating all acute trusts by December 2015 as Outstanding Good Requires Improvement Inadequate We are taking a ‘bottom up’ approach – rating each domain (e.g. safe, effective, caring …) for each service (A&E, medicine etc.) at each location. We believe this will be of greatest assistance both to patients/public and to providers and other stakeholders

Good Practice We met committed professional staff, proud to work at the Trust. We met many patients and service users who were engaged with and supportive of the Trust. We saw numerous examples of commendable practice, including: Exceptional end of life care demonstrated within the maternity department. Outstanding maternity care underpinned by information provided to women and partners and robust midwifery staffing levels with excellent access to specialist midwives. Outstanding leadership of ICU & HDU services with open and effective team working and a priority given to dissemination of information, research and training. Excellent multidisciplinary working within and across community & acute teams.

More Good Practice The functioning of the hyper acute stroke unit, short term reablement and rehabilitation service. The well led, integrated working and calm environment within A&E. Multi-professional team working in Neuro theatres. Systems developed by the trust to promote the safety of children, young people and families . An evident culture of positive learning from medicine administration errors Development and use of DVDs to engage staff with on going practice improvements.

Summary of Ratings

Headline findings (1) Staffing: The trust has increased midwifery & nursing staff levels, with staff highly committed to the delivery of good patient care and to the organisation. Staff positively chose to work at St George’s Healthcare NHS Trust. However we did find that some areas there were significant shortages of staff. These included; Childrens services and outpatients departments within the main hospital and in outpatients in Queen Mary Hospital. Outpatients: The issues in the outpatient departments were predominantly the lack of medical record availability to ensure that clinicians were undertaking the correct treatments. At Queen Mary’s Hospital the issues centred around the responsiveness of the trust in that children’s needs were not attended to and signage was an issue for some people.

Headline findings (2) End of Life Care: Within this service staff did not appear to fully understand what constituted end of life care and who could potentially benefit from access to the palliative care team. Staff were unaware of the overarching strategy in respect of end of life care. DNACPR forms were not always completed appropriately and recent audits highlighted areas that needed addressing. Mental Capacity Act: Throughout our inspection we asked staff about the act and how they would care for people with reduced capacity. We were given many different answers. There appeared a lack of understanding about the Mental Capacity Act and what steps staff should take to protect the vulnerable patient. We have asked the trust to address this issue.

Headline findings (3) Raising concerns: We heard and saw evidence that the trust had previously dealt well with staff who had raised concerns. However throughout our visit we spoke to staff from a number of areas who felt that they could not raise concerns which would be listened to. We have asked the trust to address this. Leadership: We heard from many staff groups about the visibility of the chief executive and senior leaders at the trust. Staff talked about the chief executive visiting and working on wards and departments and that he was approachable. However within the community arm of the trust there was a sense that this visibility was very limited.

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